Provider Demographics
NPI:1801210547
Name:GOINS, ROBERT (LPN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GOINS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 W VAN BUREN ST
Mailing Address - Street 2:APT 2149
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-7284
Mailing Address - Country:US
Mailing Address - Phone:623-695-3110
Mailing Address - Fax:
Practice Address - Street 1:2702 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7469
Practice Address - Country:US
Practice Address - Phone:602-381-6181
Practice Address - Fax:902-381-6192
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP047308164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse